The Lancet recently released news that the global maternal mortality has declined – these results are controversial in that other estimates don’t exactly agree. I am not going to discuss the controversy surrounding the data as the debates focus on developing countries, not developed countries like the US and Western Europe

One area that struck me was the US maternal mortality rate. This is the chances of a women dying due to pregnancy.

The US always did poorly compared to the rest of the developed world…but the news is getting worse. According to the Lancet article, the US maternal mortality was 13 deaths per 100,000 live births in 2000 (confidence interval 12-15) but in 2008 had risen to 17 deaths per 100,000 live births. To put that in context, this rate is more than twice the estimate for Canada, Japan, Australia, South Korea, Singapore and 21 of the 22 Western European countries.

Some have stated that the apparent increase is related to changes in definitions, but it is also likely that the United States’ poor results in maternal mortality rates are tied to its having the highest teenage pregnancy rate in the developed world. In 1998 there were 1,671 births per 1,000,000 capita compared with less than 700 births per 1,000,000 capita for the other countries listed. Why does this matter? Pregnant teenagers and their infants face significantly greater health risk than pregnancy women in their 20’s; this includes a maternal mortality rate of five times higher in the developing world.

Within all the debates in the United States about health care reform one thing that was missing was a set of clear facts. As people rally for better maternal care around the world, let’s also make sure that the United States takes better care of its own mothers.

Last year, the US debate over health reform took an ugly turn over the issue of maternity care, when Senator Jon Kyl of Arizona blithely declared “I don’t need [it].” Senator Debbie Stabenow of Michigan replied: “I think your mom probably did.”

The media furor over this exchange has long since died down. But I personally cannot stop thinking about it. This exchange raises issues far too important and enduring for just a flash of media attention, issues essential to the search for common ground on abortion and the fostering of universal human rights. Pro-choicers in the US pointed out Kyl’s hypocrisy as someone who calls himself “pro-life.” Many pro-lifers condemn the same contradiction.

Problem of maternal healthcare

There is plenty of scientific evidence to back up the outrage against Kyl. According to data gathered by United Nations agencies like United Nations Population Fund (UNFPA), the US ranks 29th globally in infant mortality and 41st in maternal mortality, in large part because of racial and class disparities in health care access, and because of US providers who have economic incentives not to follow the best practices available.

Healthcare for mothers: A basic right

In support of universal health care, Childbirth Connection points out that 85% of US women give birth at some point in their lives and 4.3 million do so in any given year. Twenty-three per cent of hospital discharges are of childbearing women and newborns, who account for a far larger proportion of total hospital charges than any other group of patients. As well as involving so much of the population and the health services sector, maternity care offers unique opportunities to improve the life courses and health outcomes of mothers, fetuses, and newborns.

Globally embraced documents of the universal human rights movement also support the outrage against Kyl, even though the last two of these have yet to be ratified by my country, shamefully enough. The Universal Declaration of Human Rights identifies “medical care and necessary social services” as human rights, and “motherhood and childhood” as “entitled to special care and assistance.”

CEDAW, the Convention of the Elimination of All Forms of Discrimination Against Women, asserts the responsibility of states to “ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary.” According to the Convention on the Rights of the Child, states have a responsibility to implement every child’s right to ’special safeguards and care…before as well as after birth.” This includes the “diminish[ment] of infant and child mortality” and the ensuring of “appropriate pre-natal and post-natal health care for mothers.”

A way of reducing abortion?

As a pro-lifer who affirms all of these universal human rights, I also recognize another dimension to guarantee maternity care for all, something that concerns pro-choicers, too, for different but often overlapping reasons. Along with being a right on its own, universal, guaranteed maternity care is also, not one whit less importantly, an indispensable way to alleviate situational pressures upon women towards abortion. In particular, it is helpful to reduce pressure upon the poor, including the global poor, women who have disabilities or who carry disabled babies, women of color, immigrants and refugees, and students.

According to the Guttmacher Institute, 57% of US women who have abortions are economically disadvantaged. Lack of access to free/affordable health care, including family planning services and both maternity and pediatric care, is both a cause and consequence of economic disadvantage. This also helps to explain, for example, the fact that African American women have five times as many abortions as white women.

Consequences on the poor

The consequences of denying maternity care are even more dire for the global poor. Although the withheld funds have thankfully been restored, my own government quite recently withheld $34 million per year from UNFPA, the world’s largest force for proper maternity care and other solutions to abortion, like family planning. (Contrary to what some US pro-lifers believe, UNFPA has an official policy of not promoting abortion.)

This defunding may have caused nearly 800,000 induced abortions, as well as 2 million unsought pregnancies, 4700 maternal deaths, nearly 60,000 cases of serious maternal illness, and over 77,00 neonatal and child deaths.

Even in such a wealthy nation as the US, many women’s and children’s own life and death stories also validate the right of maternity care. Although my poverty was nothing like the deep poverty of so many in the world, I vividly remember how challenging it was for me in 1986-87 as a student with disabilities to hold onto the expensive private insurance plan my daughter and I so desperately needed throughout and beyond that medical and emotional roller coaster of an unplanned, high-risk pregnancy.

Two decades later, when my college student daughter became pregnant herself, she and her baby–who turned out to have a life-threatening but correctable gut impairment– were also subjected to uncertain coverage. My grandson is a year and a half now, but we are *still* fighting the plan’s refusal to pay for his mom’s emergency asthma treatment in the eighth month of pregnancy.

And yet we were all the “lucky” ones. I can’t imagine how any of us would be alive today without the access to proper health care we somehow managed to have. I shudder to think what might have happened otherwise. This inter-generational story is but one deep source of my conviction that US society, not only Senator Kyl, must stop already in its dismissal of maternity care, a matter of life and death, as some lightweight thing that one can access only via fluke.

A universal problem

To regard maternity care as simply an option that “I don’t need” is to wash one’s hands of collective responsibility for mothers and babies and therefore to have complicity in those situational pressures towards abortion. This responsibility extends beyond those who are mothers or wish to become mothers, to every member of society. Countries that regard maternity care as everybody’s business and everybody’s concern, such as the Netherlands, have abortion rates that are a small fraction of the high US rate.

Every single one of us grew inside the body of a woman who needed access to proper health care to keep both herself and her baby alive and well. I only need to look at the faces of my daughter and grandchild and my own in the mirror to know that universal, guaranteed maternity care is a moral and political imperative everywhere. A rich country like mine must do all it can to make guaranteed maternal healthcare a reality not only for its own residents, but all women and children throughout the world.

This post is a response to the post Are pregnant women expendable?

As mobile and web technologies become increasingly accessible to those living in remote poverty around the world, the potential to expand access to health care to underserved populations becomes ever more real.

It’s exciting to see the many ways that innovative people and organizations are able to take advantage of the spread of technology to make positive social change. Ushahidi, an open-source platform that can be used by anyone to collect and visualize user-generated information, is an excellent example. They’re using mobile and web technology – including social media platforms like Twitter – to capture critical up-to-date reports from individuals in crisis areas through crowd-sourcing and filtering.

Check out this short video for Erik Hersman’s brief introduction to Ushahidi.

Ushahidi creates a hub for user-generated crisis information that comes in through text messages, tweets, and emails around a given crisis in a specific geographic area. Their team then uses the “Swift River” filtering system to determine which reports are legitimate and group them thematically. The reports are placed on an interactive map so that users can see exactly where emergencies are being reported. Right now, for example, this tool is making a difference in Haiti by helping aid workers and first responders identify where and for what the needs are greatest.

What if this tool was used for women going through labor or labor-related complications?

There are already some open-source map-based initiatives being built for the maternal health field. The Maternal Health Task Force has designed three interactive, user-generated maps that depict maternal health knowledge hubs, MPH programs offering a maternal health concentration, and organizations working in maternal health. Another key contributor is Maternova, one of the Changemakers early entry prize winners for the Healthy Mothers, Strong World competition, which is building an open-source map of maternal health care facilities around the world.

By combining these maps, which outline the maternal health “supply” worldwide, with information and interactive maps that visually depict demand, perhaps we could create a clearer, more visual picture of the true gaps in health access.

Pregnant women in need of care – or their friends and family – could text an emergency alert to a number assigned by Ushahidi. This would then be transmitted to health professionals in the region, and made widely available on the internet. Though ensuring an immediate response to the requests will take time and a larger overarching strategy, the reporting of this information alone can help direct health care facilitators to the areas most in need.

Let me know what you think about the potential to use mobile and web technologies to crowd source information for maternal health by responding to this post. To learn about other innovative ideas for maternal health, or to submit your own, visit www.changemakers.com/maternalhealth before the competition deadline, March 17th.

This piece was originally posted on the Ashoka Change InSight blog at www.ashoka.org/changeinsight.

When we talk about maternal health, it’s easy to categorize the subject as a “women’s issue.” After all, one can pretty safely say that a man will never be at risk of death for birthing a child, nor will he need to worry about any of the disabling complications that can occur in the process of giving life.

But while the physical act of childbirth is reserved for mothers, it is naive – and even harmful – to consider maternal health a topic that is reserved for women. In truly prioritizing maternal health globally, actors from all corners of each community – especially men – need to be key contributors to the dialogue.

A community working together

Click here to view the embedded video.

This short segment from Walking the Path of Unity, a documentary about female genital cutting (FGC) in Southern Senegal, does a great job of highlighting the potential for real social change when a diverse group of stakeholders works together to address an issue. What I particularly like about this video is its emphasis on husbands and traditional and religious leaders. Together, the men and women of Diégoune abolished FGC entirely in their community, an act that would have faced much more resistance if it had only been prioritized by the women and not reinforced through traditional and religious means. Though FGC is a separate issue from maternal health, the community’s response to this problem is one that can apply to any issue and that teaches us that we must all work together as a group.

This video is one piece of evidence in a string of many that emphasizes the critical role of involving non-female advocates in the maternal health movement.

Reopening the dialogue for men

Brazilian Ashoka Fellow Jorge Lyra is doing some really interesting work along these lines as well. His organization, Programa PAPAI, provides direct service, training workshops, and advocacy to expecting and new young fathers. In Brazil, where young fathers often prefer to disassociate themselves with their pregnant partners – and even their own children – he has responded by moderating discussions around key issues like sexual health and STDs, marriage and fatherhood, conception and pregnancy, and accountability. Essentially, he has reopened the dialogue for men to understand and participate in their partner’s and family’s health.

Programa PAPAI also offers workshops and discussion groups to hospital reproductive health departments on how to better incorporate men into prenatal and postnatal care. With the buy-in of all parties, he is laying the framework for maternal health to become a more universal priority.

Globally, the communities and countries that will find real, sustainable improvements for maternal health will incorporate everyone in the push, not just women, not just mothers.

This entry was originally posted on Ashoka’s Change InSight Blog at http://www.ashoka.org/newsblog.

These videos, by different human rights organizations, go beyond statistics to tell us the stories of women and their families as they struggle to understand why it is that so many women are dying during childbirth and what needs to be done to stop this.

First, the White Ribbon Alliance produced a four minute video titled Birth and Death explaining the seriousness of Maternal Mortality and how it can be stopped:

Click here to view the embedded video.

UNICEF also created a two minute video to raise awareness about this issue, with 5 steps that can be taken to diminish maternal mortality: education, respect, empowerment, investing and protection.

Click here to view the embedded video.

In this next video, In Silence: Maternal Mortality in India by Human Rights Watch, photographer Susan Meiselas and reporter Dumeetha Luthra traveled to India to follow the story of a woman who died after giving birth:

Click here to view the embedded video.

In Peru, as told by this piece done for CARE by Phil Borges, the Watchmen for Lives program to decrease maternal mortality has proven to be a success: by empowering and educating women from within the communities in the importance of healthcare during pregnancy and by making a chart for midwives with warning signs on when to send women to a clinic, more are going to clinics to give birth, dramatically reducing the numbers of deaths due to complications during labor.

Click here to view the embedded video.

Amnesty International has this documentary piece, 18 minutes long, about Maternal Mortality in Sierra Leone. One in 8 women die in Childbirth there: the inability to pay for medical attention, a practically non-existent healthcare system, lack of trained medical practitioners and understaffed and understocked clinics are the main reasons. As the women in the video tell: everyone there knows a woman who has died during pregnancy or labor.

Click here to view the embedded video.

And from Australia, students from the Nursing and Midwife program at the University of Sydney have created Birthing Kits that they’ve delivered to developing countries to try and prevent unnecessary deaths. It includes a plastic sheet to put under the mother, surgical gloves, scalpel blades, gauze, soap and string to tie off the umbilical cord. In the video, they tell of their initiative and the successful experience they’ve had in Bangladesh.

Click here to view the embedded video.

Women are drivers of development – yet the poorest women pay the highest price with their health, well-being and ultimately their lives, particularly in a time of financial crisis. Investing in women’s health is an investment in their wellbeing, their family’s wellbeing and their community; yet again this year over half a million women and girls will die unnecessarily in pregnancy and childbirth, tens of millions more will suffer illness, injury and disability.

The World Bank states that investment in family planning can reduce maternal mortality by 40 per cent. Likewise, meeting the unmet need for family planning will reduce maternal morbidity and the burden of disease and illness caused by sexual and reproductive ill-health.

Health is a human right and cornerstone of social and economic development. No one should die or suffer from preventable causes for lack of basic health services. Yet, support for population and reproductive health programmes has significantly declined as a percentage of overall health aid, from about 30 per cent in 1994, to just 12 per cent in 2008. This global crisis further threatens much of the progress made towards improving the health of poor women in poor countries during those years.

Yet even current levels of investment in sexual and reproductive health from national and donor governments are threatened by the current crisis. Girls count and women matter, yet too often they are overlooked. Now is the time to increase our efforts, not decrease them, otherwise the escalation in poverty and the impact on both present and future generations will be dramatic.